<div class="popupform regform" id="reg-form">
    <div class="left">
        <div class="pin">Register</div>
        <form name="register_form" id="register-form" action="" method="post">
            <div class="field"><input type="text" required="required" id="register_fname" class="input" name="user_first_name" value="First Name" title="First Name" onblur="if (this.value == '') {
                        this.value = this.title;
                        this.style.fontStyle = 'italic';
                        this.style.color = '#1996D4';
                    }" onfocus="if (this.value == this.title)
                        this.value = '';
                    this.style.fontStyle = 'normal';
                    this.style.color = '#000';" style="font-style: italic;" /></div>
            <div class="field"><input type="text" required="required" id="register_lname" class="input" name="user_last_name" value="Last Name" title="Last Name" onblur="if (this.value == '') {
                        this.value = this.title;
                        this.style.fontStyle = 'italic';
                        this.style.color = '#1996D4';
                    }" onfocus="if (this.value == this.title)
                        this.value = '';
                    this.style.fontStyle = 'normal';
                    this.style.color = '#000';" style="font-style: italic;" /></div>
            <br/>
            <div class="field"><input type="text" required="required" id="register_username" class="input" value="Username" name="user_username" title="Username" onblur="if (this.value == '') {
                        this.value = this.title;
                        this.style.fontStyle = 'italic';
                        this.style.color = '#1996D4';
                    }" onfocus="if (this.value == this.title)
                        this.value = '';
                    this.style.fontStyle = 'normal';
                    this.style.color = '#000';" style="font-style: italic;" /></div>
            <div class="field"><input type="text" required="required" id="register_email" class="input" name="user_email" value="Email Address" title="Email Address" onblur="if (this.value == '') {
                        this.value = this.title;
                        this.style.fontStyle = 'italic';
                        this.style.color = '#1996D4';
                    }" onfocus="if (this.value == this.title)
                        this.value = '';
                    this.style.fontStyle = 'normal';
                    this.style.color = '#000';" style="font-style: italic;" /></div>
            <div class="field"><input type="password" required="required" id="register_password" class="input" name="user_password" value="Password" title="Password" onblur="if (this.value == '') {
                        this.value = this.title;
                        this.style.fontStyle = 'italic';
                        this.style.color = '#1996D4';
                    }" onfocus="if (this.value == this.title)
                        this.value = '';
                    this.style.fontStyle = 'normal';
                    this.style.color = '#000';" style="font-style: italic;" />
            </div>
            <div class="ac">
                <input type="checkbox" name="agree_terms" value="1"/>
                <span class="remember">I understand and agree to Quick Ties <a href="<?php echo $this->baseUrl("static/privacy_policy"); ?>" class="tlink">Policy</a></span>
            </div>
            <div class="regorlog">
                <a href="#" class="fl rbox bluebutton" id="register-btn" >Register</a>
                <div class="fl already">Already have an <a href="#plog" id="account_link" class="tlink">Account?</a></div>
                <div class="cf"></div>
            </div>
        </form>
        <div class="social-profile">
            Lorem ipsum dolor sit amet, consectet <a href="#" class="tlink">Social Profile</a>
        </div>
    </div>
    <?php
        echo $this->render("extras/login-right-sidebar.phtml");
    ?>
</div>